The computer system in the hospital (2 years ago some German students installed intranet and internet, but unfortunately not much is left of this) is as good as down. Long working days, in the evening rain and lightning and thus no electricity in the internetcafé. Today I try... Cutting and pasting texts works but the photos do not come through.Later more... Some impressions as a beginning.

Monday 1st March, 2010.

OAlso today, I have faced grief in case of infertility.Flora, 29 years, and still has not given birth to a living child. Her husband now has two children with another woman. Again it becomes clear how important it is to a woman in Africa to become a mother. The social pressure is enormous. Desperation is near if this does not succeed. Exclusion and even cruelty is not unthinkable. In our Western World, we do not understand that. Here, in-vitro treatments do not exist. And if this was possible, it would be prohibitive. Though heaven and earth would be moved because giving birth to and having children is an enormous richness here!

This afternoon, I have seen Veronica and Angelina, two known midwives from ward 2. Veronica is not feeling well. She is 31 weeks pregnant, has a much to high blood pressure and does not react on the medication which is on stock here.One and a half years ago,during a previous visit of mine in Mafinga, she gave birth to a dead baby. Pre-eclampsia. Hopefully, this time it will go better.However… it does not look good. I already keep my fingers crossed that Veronica does not suffer damage and that the baby will not be born much too prematurely, otherwise she will not survive this. If Veronica and the baby would live with us, their future would not look that uncertain. What luxury we do have at home with regard to medical treatment.

I want to go home a bit earlier, passing by the market to buy asali (honey),passion fruits and bananas. How nice to breathe all the warm colours and smells. Sun on my skin, warmth in my heart.

Wednesday 3rd March, 2010. A busy day for Eise. During consultation-hours, she scheduled many patients for operations or the coming week when Ben, the anaesthetist, will come.
Today a victory! They wanted to perform a caesarean at a 16 year-old girl, her first baby, because of unadvancinglabour. This is very subjective though. According to the partogram (it has already been filled in once ;-) it looked good according to me. Why not stimulate the labour by breaking the tissues and if necessary by administering with a parturifacient???Are they (the midwives, but also the doctors) afraid of this. Of course you must then follow up on the labours. Perhaps here it is where the shoe pinches… But I was asked to give advice and this was followed. ;-) And behold, she later gave super fast birth to a girl. Hurray! Congratulations!

Thursday 4thMarch, 2010. Today another victory this time for Eise.Last year, we discussed the use of vacuumextraction. Theventouse had been abandoned already years ago. Too unsafe for the baby! A correct diagnostics and the mastering of this technique are of course of paramount importance. Unfortunately, last year, there had not been any possibility for a demonstration. Today there has been! Grace, giving birth to her first child, HIV +, taken to the clinic by ambulance, has been in the state of dilatation for a few hours, but there was no progress. An exhausted mother was the consequence. Herea beautiful vacuum birth. Hopefully, the local colleagues are now less reluctant and suspicious to this method. Doctor Innocent, a young beginner doctor who had been attached to Eise, does want to master this technique. In future, this may perhaps considerably reduce the number of caesareans!?

Today, also the three Dutch medical students have started working. Nice guys, full of energy and curiosity. Nice to see how they let come up all impressions to them.

Sunny greetings (through the raindrops, rainy season) from us all!

Eise, Ben and Mie

Jart, Jan and Floris andalso from our African colleagues :-)